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Request For Accomodation Form: Medical Exemption from Vaccination

A sample form for an employee to request exemption from required vaccinations.

This content is for CoAction Insurance policy holders.

To request portal access, send an email to losscontrol@coactionspecialty.com with “Coaction LC Portal” in the subject line and include your policy number in the email body.

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Contact Us

Phone Number: 800.774.2755

Fax: 800.326.2864

Email: support@coactionspecialty.com

Mailing Address

Coaction Specialty Insurance

412 Mount Kemble Ave.

Morristown, NJ 07960

What Should I Do After An Event Occurs?

Report the loss as soon as possible to claims@coactionspecialty.com or call 800.774.2755 (Option #1 for reporting a new claim, Option #2 for all other existing claims).

When Should I Notify Coaction About A Claim?

Immediately. When filing a claim, notify Coaction by contacting us either via email at claims@coactionspecialty.com, by phone at 800.774.2755 (Option #1 for reporting a new claim, Option #2 for all other existing claims) or fax 800.326.2864.

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